Controlled Study Research Articles

Home-based circuit training improves blood lipid profile, liver function, musculoskeletal fitness, and health-related quality of life in overweight/obese older adult patients with knee osteoarthritis and type 2 diabetes: a randomized controlled trial during the COVID-19 pandemic

BackgroundThere is strong evidence showing the association between obesity, type 2 diabetes mellitus (T2DM), and knee pain resulting from osteoarthritis. Regular exercise has been reported as a foundational piece of the preventive therapy puzzle for knee osteoarthritis (KOA) patients. Nonetheless, evidence-based exercise protocols for people with comorbidities, such as obesity, T2DM, and KOA are limited. Therefore, the present trial aimed to assess the effectiveness of a 12-week home-based circuit training (HBCT) protocol on various indices related to cardiometabolic health, musculoskeletal fitness, and health-related quality of life (HRQoL) among overweight/obese older adult patients with KOA and T2DM during the COVID-19 lockdown.MethodsThis is a randomized controlled trial study registered at the National Medical Research Register (ID: RSCH ID-21-01180-KGTNMRR ID-21-02367-FUM) and obtained approval on December 9, 2021. Seventy overweight or obese patients with KOA and T2DM (62.2 ± 6.1 years; 56% female) were randomly assigned to the intervention group (n = 35, HBCT) or the no-exercise control group (n = 35, CON). HBCT performed a 12-week progressive protocol (seven exercises; 15–30 repetitions per exercise, 1 min passive rest between exercises; 2–4 rounds per session; 20–60 min total session duration). Blood samples were collected, and assays were performed to assess the lipid profile, liver function, and fasting blood glucose (FBG). In addition, the 30-s Chair Stand Test (30CST) was used to evaluate lower body muscular strength and endurance while the Timed Up and Go (TUG) test was used to evaluate lower limb function, mobility, and the risk of falls for all the participants. HRQoL was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL). All the assessments were conducted at pre-, mid-, and post-training stages during the application or practice of the exercise protocol, rather than during the training sessions themselves.ResultsHBCT significantly reduced total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), aminotransferase, alanine aminotransferase, FBG and knee pain (p < 0.05). Furthermore, HBCT induced meaningful increases in high-density lipoprotein (HDL-C), lower body muscular strength, endurance, function, mobility, and HRQoL in overweight/obese older adults with T2DM and KOA (p < 0.05).ConclusionThe present outcomes recommend that an injury-free HBCT program may improve various indicators related to cardiometabolic health, musculoskeletal fitness, and HRQoL in elderly with overweight/obesity, T2DM and KOA. These findings offer valuable insights for clinicians and practitioners seeking evidence-based exercise interventions tailored for patients managing substantial metabolic and musculoskeletal health challenges in clinical practice.

Anomaly detection for high-content image-based phenotypic cell profiling.

High-content image-based phenotypic profiling combines automated microscopy and analysis to identify phenotypic alterations in cell morphology and provide insight into the cell's physiological state. Classical representations of the phenotypic profile can not capture the full underlying complexity in cell organization, while recent weakly machine-learning based representation-learning methods are hard to biologically interpret. We used the abundance of control wells to learn the in-distribution of control experiments and use it to formulate a self-supervised reconstruction anomaly-based representation that encodes the intricate morphological inter-feature dependencies while preserving the representation interpretability. The performance of our anomaly-based representations was evaluated for downstream tasks with respect to two classical representations across four public Cell Painting datasets. Anomaly-based representations improved reproducibility, Mechanism of Action classification, and complemented classical representations. Unsupervised explainability of autoencoder-based anomalies identified specific inter-feature dependencies causing anomalies. The general concept of anomaly-based representations can be adapted to other applications in cell biology.

Public health policy impact evaluation: A potential use case for longitudinal monitoring of viruses in wastewater at small geographic scales

Public health policy impact evaluation is challenging to study because randomized controlled experiments are infeasible to conduct, and policy changes often coincide with non-policy events. Quasi-experiments do not use randomization and can provide useful knowledge for causal inference. Here we demonstrate how longitudinal wastewater monitoring of viruses at a small geographic scale may be used in a quasi-experimental design to evaluate the impact of COVID-19 public health policies on the spread of COVID-19 among a university population. We first evaluated the correlation between incident, reported COVID-19 cases and wastewater SARS-CoV-2 RNA concentrations and observed changes to the correlation over time, likely due to changes in testing requirements and testing options. Using a difference-in-differences approach, we then evaluated the association between university COVID-19 public health policy changes and levels of SARS-CoV-2 RNA concentrations in wastewater. We did not observe changes in SARS-CoV-2 RNA concentrations associated with most policy changes. Policy changes associated with a significant change in campus wastewater SARS-CoV-2 RNA concentrations included changes to face covering recommendations, indoor gathering bans, and routine surveillance testing requirements and availability.

Examining the Impact of Assimilating Surface, PBL, and Free Atmosphere Observations from TORUS on Analyses and Forecasts of Two Supercells on 8 June 2019

Abstract This study describes data-denial experiments conducted to examine the impact of assimilating subsets of data from the TORUS project on storm-scale ensemble forecasts of two supercells on 8 June 2019. Assimilated data from TORUS includes mobile mesonet, UAS, and radiosonde observations. The TORUS data are divided into three spatial subsets to evaluate the importance of observing different parts of the atmosphere on forecasts of this case: the SFC subset consisting of just the near-surface mobile mesonet observations, the PBL subset consisting of UAS observations and radiosonde profiles below 762 m, and the FREE subset consisting of radiosonde profiles above 762 m. Data denial experiments are then conducted by comparing analyses and free forecasts generated using a cycled EnKF data assimilation system assimilating conventional observations, radar observations, and all of the TORUS observations at once with experiments where one of the three subsets is removed in turn as well as a control experiment assimilating only conventional and radar observations. Our results show that assimilating all of the TORUS observations at once in the ALL experiment improves the storm-scale ensemble forecasts much more often than it degrades them, and that no one subset of the TORUS data was consistently most important for improving the analyses or forecasts.

From cardiovascular protection to cardiovascular risk: the metamorphosis of menopausal hormone therapy.

Over the last 70years, oestrogen therapy for the management of menopausal symptoms has undergone a metamorphosis from perceived cardiovascular protection to perceived cardiovascular risk. The former perception is based on the convincing evidence from the Nurses' Health Study cohorts and the epidemiological data surrounding early menopause. The latter, and later, perception is based on the disquieting results from two randomised controlled studies, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women's Health Initiative study (WHI). The reality is probably more nuanced than the conclusions presented by any of these studies. When face to face with a patient, the clinician must negotiate the appropriate decision pathway around the interaction between cardiovascular risk, cardiovascular disease, menopause, and oestrogen +/-progestogen-containing hormone therapy.

Matrix product study of spin fractionalization in the one-dimensional Kondo insulator

The Kondo lattice is one of the classic examples of strongly correlated electronic systems. We conduct a controlled study of the Kondo lattice in one dimension, highlighting the role of excitations created by the composite fermion operator. Using time-dependent matrix product state methods, we compute various correlation functions and contrast them with both large-N mean-field theory and the strong-coupling expansion. We show that the composite fermion operator creates long-lived, charge-e and spin-1/2 excitations, which cover the low-lying single-particle excitation spectrum of the system. Furthermore, spin excitations can be thought to be composed of such fractionalized quasiparticles with a residual interaction which tend to disappear at weak Kondo coupling. Published by the American Physical Society 2024

Dietary supplementation with plant extracts for amelioration of persistent myofascial discomfort in the cervical and back regions: a randomized double-blind controlled study.

Back pain is a common health problem that affects both workers and older people, reducing their quality of life. The primary objective was to assess the effect of dietary supplementation with plant extracts of rosemary, ashwagandha, and sesame consumed for 12 weeks on the intensity of back pain. A single-center randomized double-blind study with three parallel arms depending on the product consumed. The duration of treatment was 12 weeks. The investigational product, Berelief®, contained a blend of three polyphenolic standardized extracts: rosemary (Rosmarinus officinalis L.), ashwagandha (Withania somnifera L.), and sesame (Sesamum indicum L.) seed. Two doses were tested: low dose (400 mg) and high dose (800 mg). There were 42 subjects in the placebo group, 39 in the low dose and 42 in the high dose groups. Study variables included back pain intensity [VAS score, Patient-Reported Outcomes Measurement Information System (PROMIS-29), and Cornell Musculoskeletal Discomfort Questionnaire; functionality Roland-Morris Disability (RMD) questionnaire]; quality of life (QoL) [36-item Short Form Survey (SF-36), the Beck Depression Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS)]; sleep quality [accelerometer and Pittsburgh Sleep Quality Index (PSQI)]. The improvement in back pain recorded by the visual analogue scale (VAS) at the study visits after the beginning of treatment, as well as on a weekly basis recorded in the diary card was significantly higher in the intervention group than in the placebo group (p < 0.044 dose-low; p < 0.005 dose-high). Significant differences in pain intensity of the PROMIS-29 (p = 0.002) and upper back pain in the Cornell questionnaire (p = 0.011) in favour of the investigational product were found. Furthermore, benefits in improving health-related quality of life, mood and sleep quality were also detected. Dietary supplementation for 12 weeks of a blend of polyphenolic standardized extracts of rosemary, ashwagandha, and sesame was effective in reducing the intensity of pain in subjects with chronic myofascial cervical and back pain.

Comparative analysis of therapeutic plasma exchange vs. standard management in hypertriglyceridemia-induced acute pancreatitis: triglyceride reduction and clinical outcomes.

The use of therapeutic plasma exchange (TPE) for treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) remains controversial in the literature. This study compared the clinical outcomes of TPE versus conventional therapy in patients with HTGP. Fifty-five patients with HTGP were included. Patients were retrospectively compared in pairs: those who received TPE treatment and those who did not, those whose triglyceride level fell below 500mg/dL within 48h, and those who did not, those with and without persistent organ failure. The primary outcome was the percentage of triglyceride reduction within 48h. Secondary outcomes were the length of hospital stay, mortality, cost-effectiveness, and persistent organ failure. Percentage decrease in triglyceride levels, medical hospitalization costs, and length of hospital stay were higher in the TPE group compared to the non-TPE group (p < 0.05, for each). However, there was no difference regarding persistent organ failure and mortality (p > 0.05, for each). The length of hospital stay, average cost, persistent organ failure, and mortality were similar in both groups whose triglyceride level fell below 500mg/dL within 48h and those who did not (p > 0.05, for each). Among patients with persistent organ failure, average cost was higher in the TPE group compared to the non-TPE group (p < 0.05). An independent relation was found between the average cost and persistent organ failure, TPE, length of hospital stay, albumin, and urea values in all patients (p < 0.05, for each). The approach of using TPE for treatment of HTGP was not found to be superior to the conventional treatment. Randomized controlled studies with larger number of patients are needed to gain better understanding of this issue.

Real-world effectiveness and safety of tofacitinib for alopecia areata: A retrospective cohort study of 202 patients.

Alopecia areata (AA) is an autoimmune hair loss disorder characterised by collapse of hair follicle immune privilege and mediated by autoreactive CD8+ T lymphocytes and natural killer cells. Treatment is often unsatisfactory. The Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway is implicated in the pathogenesis of AA and Janus Kinase inhibitor (JAKi) medications are promising emerging treatments for AA. We evaluated the safety and effectiveness of tofacitinib in a real-world setting over 18 months of treatment. A retrospective cohort study of all patients with scalp AA commenced on tofacitinib between 1 November 2016 and 31 May 2019. The primary endpoint was the percent change in Severity of Alopecia Tool (SALT) score at 18 months. Two hundred and two patients were included. After 18 months of treatment, 55.9%, 42.6% and 29.2% achieved 50%, 75% and 90% reductions in their SALT scores respectively. Increased duration of AA was a negative predictor of hair regrowth. Males and patients with baseline SALT ≥90 were slower to respond to treatment in the first 12 months. One hundred and twenty-four patients and 168 patients received concomitant systemic corticosteroids or low-dose oral minoxidil during tofacitinib therapy respectively. There were no serious adverse events. Tofacitinib was a safe and effective treatment for patients with moderate-to-severe AA. Further randomised controlled studies are needed to establish the optimal treatment regimen.

A systematic review of effective interventions and strategies to support the transition of older adults from driving to driving retirement/cessation

Abstract Background and Objectives In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods A search was completed across nine data bases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers was completed using the Covidence platform. Twelve papers were selected for full text screen and data extraction, comprising three papers with evidence-based intervention programs and nine papers with evidenced-informed strategies. Results Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to six themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, re-focus the process away from assessment to proactive planning, collaborative approach to enable “ownership” of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Acute anterior cruciate ligament rupture: can repair become an alternative to reconstruction: a meta-analysis of randomized controlled trials and cohort studies.

To perform a meta-analysis to compare clinical outcomes of anterior cruciate ligament (ACL) repair and ACL reconstruction for acute ACL rupture. We searched Pubmed, Embase, the Cochrane Library, and Web of Science databases to seek relevant studies. Clinical outcomes included failure rate, hardware removal rate, anteroposterior (AP) knee laxity, and patient-reported outcomes. In addition, subgroup analysis was carried out according to repair techniques, rupture locations, and study designs. Funnel plots were used to detect publication bias. All statistical analysis was performed using STATA (version 14.2, StataCorp). A total of 10 articles were included in this study, comprising 5 randomized controlled trials (RCTs) and 5 cohort studies, involving a total of 549 patients. We found no statistical differences between the ACL repair and ACL reconstruction in the following outcomes: failure rate, AP knee laxity, International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome (KOOS) Score, and Tegner score. However, the ACL repair group had a higher hardware removal rate. Except for AP knee laxity results on different repair techniques, there was no statistical difference in other subgroup analyses. Compared with ACL reconstruction, ACL repair shows similar results in clinical outcomes, and it is promising to be an effective alternative treatment for acute ACL rupture. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of ACL repair in other aspects. Level III.

Comparison of the HugeMed video laryngoscope with the Macintosh direct laryngoscope for nasotracheal tracheal intubation in children undergoing dental treatment: a randomized controlled clinical study

ABSTRACT Objectives The aim of this study was to compare the performance of the HugeMed® videolaryngoscope with a direct Macintosh laryngoscope for nasotracheal intubation. Methods Eighty-eight children aged 4–10 years were randomly assigned to either the HugeMed® videolaryngoscope (HVL) or the Macintosh direct laryngoscope (MDL) group. Intubation difficulty, glottic view grade, time-to-intubation, number of tracheal intubation attempts, use of external laryngeal manipulation and Magill forceps, recovery time, pediatric-anesthesia-delirium-scale (PAEDS) scores, pain due to tracheal intubation, and laryngeal bleeding were evaluated. Results Easy tracheal intubation incidence was higher in the HVL group than that in the MDL group (p = 0.001). Glottic view was better in the HVL group as compared to the MDL group (p = 0.027). There was no difference between the groups in terms of time-to-tracheal intubation, number of tracheal intubation attempts, Magill forceps usage, pain, and bleeding due to tracheal intubation. The need for external laryngeal manipulation (p = 0.004) and PAEDS scores (p = 0.006) were higher in the MDL group than those in the HVL group. Conclusion HugeMed® videolaryngoscope may provide easier tracheal intubation, create a better glottic view, and significantly reduce the need for additional manipulation compared to the Macintosh direct laryngoscope, for nasotracheal intubation. Clinical trial registration www.clinicaltrial.gov identifier is NCT05121597

“Comparison of activated Platelet Rich Fibrin and Platelet Rich Fibrin in osseous regeneration of freshly extracted socket- A double blinded randomized clinical study”

IntroductionDental extraction is a common oral surgery procedure, but it can lead to unpredictable changes in alveolar bone structure, which can complicate future rehabilitation with prostheses. Socket preservation aims to reduce bone and soft tissue loss after extraction and involves various techniques using different materials. Autogenous bone is considered the gold standard for grafts, while autologous platelet concentrates like platelet-rich fibrin (PRF) have been used for tissue healing. This study aims to radiographically assess the bone remodeling of freshly extracted socket filled with Activated Platelet Rich Fibrin (APRF) and PRF. Materials and methodsA randomized controlled study was conducted on 60 patients undergoing tooth extraction as atraumatic as possible. Patients were divided into two groups: one receiving APRF with 10% Calcium Chloride as activating agent and the other PRF. Radiographic assessments were done using Kelley et al. scoring criteria at various time intervals, and statistical analyses were performed to evaluate the results. ResultsIn this study we found increased bone density in extracted socket filled with APRF at any given time interval compared to PRF which is statistically significant. The maxilla demonstrated better bone formation compared to the mandible. Gender, age, and site also influenced bone formation, with females showing differences in lamina dura and overall density. DiscussionPRF is rich in growth factors, promoting osteoblast formation and angiogenesis. Activation with calcium chloride accelerates clot formation and the release of growth factors. This study's radiographic data suggests that APRF may be more effective than PRF in promoting socket preservation and bone formation.

Amiloride versus furosemide for the treatment of edema in patients with nephrotic syndrome: A pilot study (AMILOR).

In rodent models of nephrotic syndrome (NS), edema formation was prevented by blockade of the epithelial sodium channel ENaC with amiloride. However, apart from case reports, there is no evidence favoring ENaC blockade in patients with NS. The monocentric randomized controlled AMILOR study investigated the antiedematous effect of amiloride (starting dose 5 mg/day, max. 15 mg/day) in comparison to standard therapy with the loop diuretic furosemide (40 mg/day, max. 120 mg/day) over 16 days. Overhydration (OH) was measured by bioimpedance spectroscopy (BCM, Fresenius). Depending on the OH response, diuretic dose was adjusted on days 2, 5, 8 and 12, and if necessary, hydrochlorothiazide (HCT) was added from d8 (12.5 mg/day, max. 25 mg/day). The primary endpoint was the decrease in OH on d8. The study was terminated prematurely due to insufficient recruitment and a low statistical power due to a low actual effect size. Median baseline OH was +26.4 (interquartile range 15.5-35.1)% extracellular water (ECW) in the amiloride arm and + 27.9 (24.1-29.4)% ECW in the furosemide arm and decreased by 1.95 (0.80-6.40) and 5.15 (0.90-8.30)% ECW after 8 days, respectively, and by 10.10 (1.30-14.40) and 7.40 (2.80-10.10)% ECW after 16 days, respectively. OH decrease on d8 and d16 was not significantly different between both arms. The AMILOR study is the first randomized controlled pilot study suggesting a similar antiedematous effect as furosemide. Further studies are required to better define the role of amiloride in NS (EudraCT 2019-002607-18).

Niobium Oxides: The key role of hydroxylated surface on photocatalytic driven C-C reductive coupling of acetophenone

Aromatic diols play a pivotal role in various industries as crucial components of bulk feedstock and fine chemicals, particularly in pharmaceutical production. However, the complexity of the chemical reactions involved in their synthesis often poses challenges for achieving high yields and purity. This study introduces an alternative approach for the synthesis of 2,3-diphenylbutane-2,3-diol (DPB) and 2-phenylbutane-2,3-diol (PB) using niobium oxides as photocatalysts for C-C reductive coupling with acetophenone as the substrate. Niobium oxides were synthesized from commercially available niobic acid (HY-340) via calcination at various temperatures. The characterization data revealed the critical impact of thermal treatment on the acid-hydroxylated surface groups of niobic acid, which strongly influenced the photocatalytic performance. Therefore, niobic acid emerged as the most active photocatalyst, achieving yields of 32.0% and 35.1% for PB and DPB, respectively, after 2 h of UV irradiation. Control experiments were conducted in conjunction with electron paramagnetic resonance and electrochemical impedance measurements to elucidate the mechanistic pathways governing the formation of DPB and PB, and to shed light on the significant role played by the surface structure of niobic acid in influencing the photocatalytic performance. This study not only provides valuable insights into the synthesis of aromatic diols but also emphasizes the significance of tailoring the surface properties of niobium oxide catalysts to enhance reactivity in photochemical processes.

Polymerase Chain Reaction Cleaner with Antibacterial Effect and Faster Elimination of Nucleic Acid Aerosol Pollution

With advancement of nucleic acid detection technology, most universities, biological testing companies, and hospitals have Polymerase Chain Reaction (PCR) laboratories. PCR detection technology is the core technology for nucleic acid detection. When nucleic acid detection is performed in a PCR laboratory, nucleic acid aerosol samples are often dispersed to the environment in the form of aerosols. At this time, there will be some nucleic acid contamination in the PCR laboratory, resulting in false positive samples. The purpose of this paper is to propose a new type of nucleic acid pollution scavenger called PCR Cleaner. Firstly, the best ratio of PCR Cleaner was obtained by a control experiment, and then the antibacterial test for the PCR Cleaner was carried by comparing the nucleic acid pollution removal efficiency of different ratios of PCR Cleaner and common nucleic acid pollution scavenger on the surface and in the air. Experiment results showed that, the removal efficiency of PCR Cleaner on the surface of nucleic acid was much higher than that of alcohol and aqueous solution. Its effect was good enough when compared to the two commonly used nucleic acid pollution scavengers (DNA/RNA-ExitusPlus and PCR clean). The antibacterial and bacteriostatic PCR Cleaner can significantly inhibit the growth of high concentration of E. coli, and can also completely inhibit the low concentration of E. coli.

Effects of Different Volumes of Ropivacaine for Pericapsular Nerve Group Block on Incidence of Quadriceps Weakness and Analgesic Efficacy Following Hip Arthroplasty: A Randomized Controlled Trial.

The pericapsular nerve group (PENG) block has been shown to be an effective approach to alleviating pain and reducing the need for opioids among older adults following hip surgery, with possible motor-sparing effects. No reports to date, however, have described appropriate ropivacaine volumes for use in the context of PENG block. The present prospective randomized controlled study was thus developed to assess the quadriceps muscle strength and analgesic efficacy associated with PENG block performed using three different volumes of 0.33% ropivacaine following general anesthesia in older adults undergoing hip arthroplasty. In this prospective randomized double-blind controlled clinical study, 60 patients were assigned at random to undergo ultrasound-guided PENG block for hip arthroplasty using different volumes of ropivacaine. Specifically, these patients were administered 10ml (Group A, n = 20), 20ml (Group B, n = 20), or 30ml (Group C, n = 20) of 0.33% ropivacaine. Quadriceps muscle strength was evaluated at 6h post-surgery. Visual analog scale (VAS) scores at rest and with movement were assessed at 4, 6, 12, and 24h post-surgery. Block duration, adverse event incidence, and patient satisfaction were evaluated at 24h post-surgery. Quadriceps motor block incidence rates at 6h post-surgery in the 10ml, 20ml, and 30ml groups were 5%, 20%, and 75%, respectively. Quadriceps muscle weakness at 6h post-surgery was significantly more common in the 30ml group relative to the others (p < 0.001). Patients administered 10ml 0.33% ropivacaine exhibited significantly higher VAS pain scores at rest and with movement relative to those patients in the 20ml and 30ml treatment groups at all time points (p < 0.05). No apparent differences in analgesic efficacy were observed when comparing the 20ml and 30ml groups at 4, 6, 12, and 24h post-surgery. No significant differences in block duration, satisfaction, or adverse event incidence were observed among groups. The preservation of motor function in the 20ml 0.33% ropivacaine group was superior to that in the 30ml 0.33% ropivacaine group. Relative to the group that received 10ml 0.33% ropivacaine during PENG block, those elderly patients administered 20ml and 30ml volumes of 0.33% ropivacaine experienced superior postoperative pain relief following hip arthroplasty.

Efficacy of 10%,25% and 50% dextrose in the treatment of hypoglycemia in the emergency department – A randomized controlled study

IntroductionDocumented symptomatic hypoglycemia is defined as “event during which typical symptoms of hypoglycemia are accompanied by measured blood glucose of ≤70 mg/dL. Most of the studies and recommendations for the unconscious hypoglycemic adult advocate the use of 25 g of glucose as 50 mL of 50% dextrose solution intravenous or 1 mg of intramuscular glucagon. ObjectiveTo compare the efficacy and safety of 5 g boluses of 10%, 25% and 50% dextrose in the treatment of hypoglycemic patients presenting to our emergency department. MethodsThis was a randomized controlled single blinded study. Hypoglycemic patients in altered mental status were randomized into three treatment arms to be administered 10%, 25% or 50% dextrose. 5 g aliquots of intravenous 10%,25% or 50% dextrose were administered over 1 min. Time taken to achieve a Glasgow Coma Scale (GCS) of 15 and median total doses (g) were the primary outcomes. ResultsData of 204 patients were analysed in the study. There was no difference in the median time to achieve a GCS of 15 in all three treatment arms (6 min). Total median dose administered in the 10% and 25% groups was lower than 50% (10 g vs 15 g). Proportion of patients who received the maximum dose of 25 g was higher in the 50% group as compared to 10% and 25% groups (12%, 3%, 4%). ConclusionThere was no difference in 10% dextrose and 25% dextrose as compared to 50% dextrose in achieving the baseline mental status (or GCS 15) in the treatment of hypoglycemia in the ED.

Efficacy of subsequent treatments after disease progression on CDK4/6 inhibitors therapy in patients with hormone receptor-positive metastatic breast cancer: A Kaplan-Meier derived individual-patient data meta-analysis.

1065 Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) are standard-of-care for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/ HER2-) metastatic breast cancer (mBC). Yet, disease progression is common in these patients. In the absence of established guidelines for optimal sequencing post-progression, we conducted a pooled analysis of patient data to assess the efficacy of subsequent treatment options following disease progression on CDK4/6i therapy. Methods: We conducted a systematic review and meta-analysis, searching PubMed, Embase, Cochrane, and conference proceedings for randomized controlled trials (RCTs) and observational cohort studies reporting subsequent treatment post-CDK4/6i progression in patients with HR+HER2-mBC from 2016 to December 2023. We performed a pooled analysis of Kaplan-Meier-derived individual patient data for progression-free survival (PFS) and overall survival (OS). Subgroups analysis according to drug type, and a sensitivity analysis including only RCTs were also conducted. Statistical analysis was performed with R Statistical Software. Results: Of 12,895 identified records, 18 studies (7 RCTs and 11 cohort studies) comprising 4,868 patients with HR+HER2-mBC were included. Maintaining treatment with a CDK4/6i post-CDK4/6i progression was associated with longer PFS (HR: 0.64; 95% CI: 0.54-0.76; p&lt;0.01; n=1,397) and prolonged OS (HR: 0.70; 95% CI: 0.61-0.79; p&lt;0.01; n=2,369) compared with ET monotherapy. The PFS benefit was seen in both continuing the prior CDK4/6i (HR 0.62; 95%CI: 0.54-0.72; p&lt;0.01; n=1,178) or switching to a different CDK4/6i (HR 0.49; 95%CI: 0.30-0.82; p&lt;0.01; n=638). Subsequent therapy with PI3K/AKT/mTOR inhibitors plus ET also achieved longer PFS (HR: 0.74; 95% CI: 0.61-0.90; p&lt;0.01; n=744), but significantly shorter OS (HR 1.36; 95%CI: 1.09-1.71; p&lt;0.01; n=1,564) compared with ET monotherapy. PFS with chemotherapy was not different from ET monotherapy (HR 0.93; 95%CI: 0.76-1.13; p=0.45; n=879) but exhibited shorter OS (HR 1.55; 95%CI: 1.38-1.72; p &lt; 0.01; n=2,476). Sensitivity analyses including only RCTs, confirmed the greater PFS of maintaining CDK4/6i plus ET compared with ET monotherapy (HR: 0.69 95% CI: 0.57-0.83; p&lt;0.01; n=751). Conclusions: This extensive data pool of RCTs and cohort studies suggests the potential clinical benefit of continued CDK4/6i after disease progression compared to ET monotherapy. Data from phase III trials will further aid in understanding this question. Our data also supports current guideline recommendations of ET-based therapies over chemotherapy as the preferred treatment sequencing in HR+ HER2- mBC.

Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol

IntroductionYoung people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format...